Provider Demographics
NPI:1811206139
Name:ELSIBAI, RABIH YOUSSEF
Entity type:Individual
Prefix:
First Name:RABIH
Middle Name:YOUSSEF
Last Name:ELSIBAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 HEATHER DR APT A113
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4134
Mailing Address - Country:US
Mailing Address - Phone:313-525-2425
Mailing Address - Fax:
Practice Address - Street 1:9215 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3730
Practice Address - Country:US
Practice Address - Phone:313-525-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist